2022-10-01 COI.pdf

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECT

PRO-POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $

DAMAGE TO RENTED

EACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe under DESCRIPTION OF OPERATIONS below

(Mandatory in NH)

OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOS

NON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSD

ADDL

WVD

SUBR

N / A

(Ea accident)

(Per accident)

OTHER:

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSURED

PHONE

(A/C, No, Ext):

PRODUCER

ADDRESS:

E-MAIL

FAX

(A/C, No):

CONTACT

NAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

4,000,000

11000

2,000,000

19038 14974

Travelers Casualty and Surety Compa

1,000,000

Twin City Fire Insurance Company Sentinel Insurance Company

615-444-8509 615-444-8509

4,000,000

01/25/2022

C

01/25/2022

615-444-8859 615-444-8859

A

4,000,000

4,000,000

10,000 1,000,000

01/25/2021

10,000

1,000,000N

01/25/2021

20 SBM TO2843 DV

20 WEC ZT2658

2,000,000

01/25/21

Honsha, Inc.

1420 Montelena Court

Professional liability

01/25/2021

10/01/2021

BIS, Inc.

1,000,000

12/29/2021

01/25/2022

10/01/2022 $5,000 retention $2,000,000/$2,000,000

Consultant - Business and Management The State of Arizona, and its officers, directors, agents, subsidiaries, and employees are named as Additional Insured on a primary and non-contributory basis as included in policy form SS0008.0405 attached to this policy. Commercial General Liability insurance is written on a primary and non-contributory basis. Commercial General Liability, Automobile Liability and Workers Compensation policies contain a waiver of subrogation endorsement, as required by this written agreement, in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

106376685

20 SBM TO2843 DV

Vista, CA 92084 a_beard@comcast.net

2,000,000

01/25/22

Lebanon, TN 37087

BIS, Inc.

834 Bradshaw Road

1324 N. 22nd Avenue The State of Arizona/ ADOT

Phoenix AZ 85009

20 SBM TO2843 DV

A

B

A a8812 Accepted

8711 UNIVERSITY EAST DRIVE

CHARLOTTE NC 28213

(866) 467-8730

(866) 467-8730

(866) 467-8730

(866) 467-8730

SUE N SHRUM/PHS

The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155

Select Customer Insurance Center

Policyholder, please call us at:

Agent, please call us at:

INSURANCE ENDORSEMENT

ATTACHED

*** PLEASE REVIEW THE CHANGE ***

Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes:

Policyholder, please call us at:

Agent, please call us at: between 7 A.M. and 7 P.M. CST .

The premium billing will be mailed to you separately. You can expect to receive it soon.

Thank you for allowing us to service your business needs.

THE HARTFORD SELECT CUSTOMER INSURANCE CENTER

12/26/21 01/25/21

01/25/22

20 SBM TO2843 DV

HONSHA INC

10755 SCRIPPS POWAY PKWY STE 513

SAN DIEGO CA 92131

12/26/21

SUE N SHRUM/PHS

246904

SENTINEL INSURANCE COMPANY, LIMITED

ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING

STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK

ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS.

THIS IS NOT A BILL.

NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE

LOCATION 001 BUILDING 001 IS REVISED

FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE:

IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION

PRO RATA FACTOR: 0.682

THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN.

Form SS 12 11 04 05 T Page Process Date: Policy Effective Date:

Policy Expiration Date:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

POLICY CHANGE

This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below:

Policy Number:

Named Insured and Mailing Address;

Policy Change Effective Date: Effective hour is the same as stated in the Declarations Page of the Policy.

Policy Change Number:

Agent Name:

Code:

POLICY CHANGES:

20 SBM TO2843

ADDITIONAL INSURED - PERSON-ORGANIZATION

LOC 001 BLDG 001

STATE OF ARIZONA/ADOT

1324 N. 22ND AVENUE

PHOENIX, AZ 85009

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS,

COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND

EMPLOYEES AS ADDITIONAL INSURED, A BUSINESS WAIVER OF SUBROGATION

APPLIES.

003 001

01/25/22

POLICY NUMBER:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Printed in U.S.A. PageForm IH 12 00 11 85 T SEQ. NO.

Process Date: 12/26/21 Expiration Date:

SCPHS016

THE HARTFORD

BUSINESS SERVICE CENTER

3600 WISEMAN BLVD

SAN ANTONIO TX 78251 December 26, 2021

HONSHA INC

10755 SCRIPPS POWAY PKWY

STE 513

SAN DIEGO CA 92131

Policy Information:

Policy Number: 20 WEC ZT2658

INSURANCE ENDORSEMENT ATTACHED

*** PLEASE REVIEW THE CHANGE ***

Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes, Please contact us.

The premium billing will be mailed to you separately. You can expect to receive it soon.

Thank you for allowing us to service your business needs.

Sincerely, Your Hartford Service Team

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Countersigned by

Authorized Representative

(1) Printed in U.S.A. Page 1Form WC 99 00 06 A Process Date: 12/26/21 Policy Expiration Date: 01/25/22

CHANGE IN INFORMATION PAGE

INSURER: See Attached Endorsement NCCI Company Number: Audit Period: ANNUAL Policy Effective Date: 01/25/21 Policy Expiration Date: 01/25/22 Policy Number: 20 WEC ZT2658 Effective Date: 01/25/21 Named Insured and Address:

Endorsement Number: 4 Effective hour is the same as stated on the Information Page of the policy.

HONSHA INC

10755 SCRIPPS POWAY PKWY STE 513

SAN DIEGO CA 92131

FEIN Number: 27-1698932 Producer Name: SUE N SHRUM/PHS Producer Code: 20246904 It is agreed that the policy is amended as follows:

This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford. If you are enrolled in repetitive EFT draws from your bank account, changes in premium will change future draw amounts.

In consideration of no change in premium, it is agreed that:

Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Form WC 00 03 13 Printed in U.S.A.

WAIVER OF OUR RIGHT TO RECOVER

FROM OTHERS ENDORSEMENT

Policy Number:

Endorsement Number:

Effective Date:

Effective hour is the same as stated on the Information Page of the policy.

Named Insured and Address:

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

SCHEDULE

20 WEC ZT2658POLICY NUMBER:

20 WEC ZT2658

December 26, 2021

HONSHA INC

10755 SCRIPPS POWAY PKWY

STE 513

SAN DIEGO CA 92131

STATE OF ARIZONA/ADOT

1324 N. 22ND AVENUE

PHOENIX, AZ 85009

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND EMPLOYEES AS ADDITIONAL INSURED, A

BUSINESS WAIVER OF SUBROGATION APPLIES.

BUSINESS LIA BILITY COVERA GE FORM

Form SS 00 08 04 05 © 2005, The Hartford a8812 Accepted

QUICK REF ERENCE

BUSINESS LIA BIL ITY COVERAGE FORM

READ YOUR POLICY CAREFULL Y

BUSINESS LIABILITY COVERAGE FORM Beginning on Page

A. COVERAGES 1

1Business Liability 2Medical Expenses 2Coverage Extension - Supplementary Payments

B. EXCLUSIONS 3

C. WHO IS AN INSURED 10

D. LIABILITY AND MEDICAL EXPENSES

LIMITS OF INSURANCE 14

E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS 15

1. 15Bankruptcy

2. 15Duties In The Event Of Occurrence, Offense, Claim Or Suit

3. 16Financial Responsibility Laws

4. 16Legal Action Against Us

5. 16Separation Of Insureds

6. 16Representations

7. 16Other Insurance

8. 17Transfer Of Rights Of Recovery Against Others To Us

F. OPTIONAL ADDITIONAL INSURED COVERAGES 18

18Additional Insureds

G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 20

Form SS 00 08 04 05

ABCDEFGHIJ

BUSINESS LIA BILITY COVERA GE FORM

Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered.

Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the stock insurance company member of The Hartford providing this insurance.

CThe word "insured" means any person or organization qualifying as such under Section . - Who Is An Insured.

GOther words and phrases that appear in quotation marks have special meaning. Refer to Section . - Liability And Medical Expenses Definitions.

(a) The "bodily injury" or "property A. COVERAGES damage" is caused by an 1. BUSINESS LIABILITY COVERAGE (BODILY "occurrence" that takes place in the INJURY, PROPERTY DAMAGE, PERSONAL "coverage territory";AND ADVERTISING INJURY)

(b) The "bodily injury" or "propertyInsu rin g Agreemen t damage" occurs during the policy

a. We will pay those sums that the insured period; and becomes legally obligated to pay as (c) Prior to the policy period, no insured damages because of "bodily injury", 1.listed under Paragraph of Section "property damage" or "personal and C. – Who Is An Insured and no advertising injury" to which this insurance "employee" authorized by you to give applies. We will have the right and duty to or receive notice of an "occurrence" defend the insured against any "suit" or claim, knew that the "bodily injury" seeking those damages. However, we will or "property damage" had occurred, have no duty to defend the insured against in whole or in part. If such a listed any "suit" seeking damages for "bodily insured or authorized "employee" injury", "property damage" or "personal and knew, prior to the policy period, that advertising injury" to which this insurance the "bodily injury" or "property does not apply. damage" occurred, then any We may, at our discretion, investigate any continuation, change or resumption "occurrence" or offense and settle any claim of such "bodily injury" or "property or "suit" that may result. But: damage" during or after the policy period will be deemed to have been(1) The amount we will pay for damages is known prior to the policy period.D.limited as described in Section -

(2) To "personal and advertising injury" Liability And Medical Expenses Limits caused by an offense arising out of your Of Insurance; and business, but only if the offense was(2) Our right and duty to defend ends when committed in the "coverage territory" we have used up the applicable limit of during the policy period.insurance in the payment of judgments,

c. "Bodily injury" or "property damage" will be settlements or medical expenses to which deemed to have been known to have this insurance applies.

occurred at the earliest time when any No other obligation or liability to pay sums or

1.insured listed under Paragraph of Section perform acts or services is covered unless C. – Who Is An Insured or any "employee" explicitly provided for under Coverage authorized by you to give or receive noticeExtension - Supplementary Payments.

of an "occurrence" or claim:

b. This insurance applies:

(1) Reports all, or any part, of the "bodily

(1) To "bodily injury" and "property injury" or "property damage" to us or damage" only if: any other insurer;

Form SS 00 08 04 05 Page 1 of 24 © 2005, The Hartford

BUSINESS LIABILITY COVERAGE FORM

(2) b.Receives a written or verbal demand or We will make these payments regardless of claim for damages because of the "bodily fault. These payments will not exceed the injury" or "property damage"; or applicable limit of insurance. We will pay reasonable expenses for:(3) Becomes aware by any other means that (1)"bodily injury" or "property damage" has First aid administered at the time of an occurred or has begun to occur. accident;

d. (2)Damages because of "bodily injury" include Necessary medical, surgical, x-ray and damages claimed by any person or dental services, including prosthetic organization for care, loss of services or devices; and death resulting at any time from the "bodily (3) Necessary ambulance, hospital, injury". professional nursing and funeral

e. Inci dental Medical Malpractice services.

(1) "Bodily injury" arising out of the 3. COVERAGE EXTENSION -rendering of or failure to render SUPPLEMENTARY PAYMENTS professional health care services as a a. We will pay, with respect to any claim or physician, dentist, nurse, emergency "suit" we investigate or settle, or any "suit" medical technician or paramedic shall against an insured we defend:

be deemed to be caused by an

(1) All expenses we incur."occurrence", but only if:

(2) Up to $1,000 for the cost of bail bonds (a) The physician, dentist, nurse, required because of accidents or traffic emergency medical technician or law violations arising out of the use of paramedic is employed by you to any vehicle to which Business Liability provide such services; and Coverage for "bodily injury" applies. We

(b) You are not engaged in the do not have to furnish these bonds.

business or occupation of providing

(3) The cost of appeal bonds or bonds to such services.

release attachments, but only for bond

(2) For the purpose of determining the amounts within the applicable limit of limits of insurance for incidental medical insurance. We do not have to furnish malpractice, any act or omission these bonds.

together with all related acts or

(4) All reasonable expenses incurred by the omissions in the furnishing of these insured at our request to assist us in the services to any one person will be investigation or defense of the claim or considered one "occurrence".

"suit", including actual loss of earnings

2. MEDICAL EXPENSES up to $500 a day because of time off Insu rin g Agreemen t from work.

a. We will pay medical expenses as described (5) All costs taxed against the insured in below for "bodily injury" caused by an the "suit".

accident: (6) Prejudgment interest awarded against

(1) On premises you own or rent; the insured on that part of the judgment we pay. If we make an offer to pay the (2) On ways next to premises you own or applicable limit of insurance, we will not rent; or pay any prejudgment interest based on (3) Because of your operations;

that period of time after the offer.

provided that:

(7) All interest on the full amount of any

(1) The accident takes place in the judgment that accrues after entry of the "coverage territory" and during the judgment and before we have paid, policy period; offered to pay, or deposited in court the part of the judgment that is within the (2) The expenses are incurred and reported applicable limit of insurance.to us within three years of the date of the accident; and (1) (7)Any amounts paid under through above will not reduce the limits of insurance.(3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require.

Page 2 of 24 Form SS 00 08 04 05

b. If we defend an insured against a "suit" So long as the above conditions are met, and an indemnitee of the insured is also attorneys' fees incurred by us in the named as a party to the "suit", we will defense of that indemnitee, necessary defend that indemnitee if all of the litigation expenses incurred by us and following conditions are met: necessary litigation expenses incurred by the indemnitee at our request will be(1) The "suit" against the indemnitee paid as Supplementary Payments.seeks damages for which the insured has assumed the liability of the Notwithstanding the provisions of 1.b.(b) B.indemnitee in a contract or agreement Paragraph of Section – that is an "insured contract"; Exclusions, such payments will not be deemed to be damages for "bodily (2) This insurance applies to such liability injury" and "property damage" and will assumed by the insured;

not reduce the Limits of Insurance.

(3) The obligation to defend, or the cost of Our obligation to defend an insured's the defense of, that indemnitee, has indemnitee and to pay for attorneys' fees also been assumed by the insured in and necessary litigation expenses as the same "insured contract";

Supplementary Payments ends when:

(4) The allegations in the "suit" and the

(1) We have used up the applicable limit information we know about the of insurance in the payment of "occurrence" are such that no conflict judgments or settlements; orappears to exist between the interests

(2)of the insured and the interest of the The conditions set forth above, or the indemnitee; terms of the agreement described in

(6)Paragraph above, are no longer met.(5) The indemnitee and the insured ask us to conduct and control the defense B. EXCLUSIONS of that indemnitee against such "suit" 1. Appl icab le To Busin ess L iabil ity Coverag e and agree that we can assign the

This insurance does not apply to:same counsel to defend the insured and the indemnitee; and a. Expected Or Intend ed Injury

(6) The indemnitee: (1) "Bodily injury" or "property damage" expected or intended from the (a) Agrees in writing to:

standpoint of the insured. This (i) Cooperate with us in the exclusion does not apply to "bodily investigation, settlement or injury" or "property damage" resulting defense of the "suit";

from the use of reasonable force to

(ii) Immediately send us copies of protect persons or property; or any demands, notices, (2) "Personal and advertising injury" arising summonses or legal papers out of an offense committed by, at the received in connection with direction of or with the consent or the "suit";

acquiescence of the insured with the (iii ) Notify any other insurer whose expectation of inflicting "personal and coverage is available to the advertising injury".

indemnitee; and b. Contractu al Liabi li ty

(iv) Cooperate with us with (1) "Bodily injury" or "property damage"; or respect to coordinating other

(2) "Personal and advertising injury"applicable insurance available to the indemnitee; and for which the insured is obligated to pay damages by reason of the assumption of(b) Provides us with written liability in a contract or agreement.authorization to:

This exclusion does not apply to liability (i) Obtain records and other for damages because of:information related to the

"suit"; and (a) "Bodily injury", "property damage" or "personal and advertising injury" that(ii) Conduct and control the the insured would have in thedefense of the indemnitee in absence of the contract orsuch "suit".

agreement; or

Form SS 00 08 04 05 Page 3 of 24

(b) (b)"Bodily injury" or "property damage" Performing duties related to the assumed in a contract or agreement conduct of the insured’s business, or that is an "insured contract", (2) The spouse, child, parent, brother or provided the "bodily injury" or sister of that "employee" as a "property damage" occurs (1)consequence of above.

subsequent to the execution of the This exclusion applies:

contract or agreement. Solely for

(1) Whether the insured may be liable as the purpose of liability assumed in an employer or in any other capacity; an "insured contract", reasonable andattorneys' fees and necessary litigation expenses incurred by or for (2) To any obligation to share damages a party other than an insured are with or repay someone else who must deemed to be damages because of pay damages because of the injury.

"bodily injury" or "property damage" This exclusion does not apply to liability provided: assumed by the insured under an "insured

(i) Liability to such party for, or for contract".

the cost of, that party’s defense f. Polluti on has also been assumed in the

(1) "Bodily injury", "property damage" or same "insured contract", and "personal and advertising injury"

(ii) Such attorneys' fees and arising out of the actual, alleged or litigation expenses are for threatened discharge, dispersal, defense of that party against a seepage, migration, release or escape civil or alternative dispute of "pollutants":

resolution proceeding in which

(a) At or from any premises, site or damages to which this location which is or was at anyinsurance applies are alleged.

time owned or occupied by, or

c. Liquor L iabil ity rented or loaned to any insured.

"Bodily injury" or "property damage" for However, this subparagraph does which any insured may be held liable by not apply to:

reason of: (i) "Bodily injury" if sustained within

(1) Causing or contributing to the a building and caused by intoxication of any person; smoke, fumes, vapor or soot produced by or originating from(2) The furnishing of alcoholic beverages to equipment that is used to heat,a person under the legal drinking age or cool or dehumidify the building,under the influence of alcohol; or or equipment that is used to

(3) Any statute, ordinance or regulation heat water for personal use, by relating to the sale, gift, distribution or the building's occupants or their use of alcoholic beverages. guests;

This exclusion applies only if you are in the (ii) "Bodily injury" or "property business of manufacturing, distributing, damage" for which you may be selling, serving or furnishing alcoholic held liable, if you are a beverages. contractor and the owner or

d. Workers' Comp ensati on And Simil ar lessee of such premises, site or Laws location has been added to your Any obligation of the insured under a policy as an additional insured workers' compensation, disability benefits with respect to your ongoing or unemployment compensation law or operations performed for that any similar law. additional insured at that premises, site or location ande. Employer’s Liabi li ty such premises, site or location"Bodily injury" to:

is not and never was owned or

(1) An "employee" of the insured arising occupied by, or rented or out of and in the course of: loaned to, any insured, other

(a) Employment by the insured; or than that additional insured; or

Page 4 of 24 Form SS 00 08 04 05

(iii ) "Bodily injury" or "property released as part of the damage" arising out of heat, operations being performed smoke or fumes from a by such insured, contractor or "hostile fire"; subcontractor;

(b) (ii)At or from any premises, site or "Bodily injury" or "property location which is or was at any damage" sustained within a time used by or for any insured or building and caused by the others for the handling, storage, release of gases, fumes or disposal, processing or treatment vapors from materials brought of waste; into that building in connection with operations being performed(c) Which are or were at any time by you or on your behalf by atransported, handled, stored, contractor or subcontractor; ortreated, disposed of, or processed

(iii )as waste by or for: "Bodily injury" or "property damage" arising out of heat, (i) Any insured; or smoke or fumes from a

(ii) Any person or organization for "hostile fire"; or whom you may be legally

(e) At or from any premises, site orresponsible;

location on which any insured or any

(d) At or from any premises, site or contractors or subcontractors location on which any insured or working directly or indirectly on any any contractors or subcontractors insured’s behalf are performing working directly or indirectly on operations if the operations are to any insured's behalf are test for, monitor, clean up, remove, performing operations if the contain, treat, detoxify or neutralize, "pollutants" are brought on or to or in any way respond to, or assess the premises, site or location in the effects of, "pollutants".

connection with such operations

(2) Any loss, cost or expense arising out by such insured, contractor or of any:subcontractor. However, this (a)subparagraph does not apply to: Request, demand, order or statutory or regulatory requirement that any(i) "Bodily injury" or "property insured or others test for, monitor,damage" arising out of the clean up, remove, contain, treat,escape of fuels, lubricants or detoxify or neutralize, or in any wayother operating fluids which are respond to, or assess the effects of,needed to perform the normal "pollutants"; orelectrical, hydraulic or

(b)mechanical functions Claim or suit by or on behalf of a necessary for the operation of governmental authority for "mobile equipment" or its parts, damages because of testing for, if such fuels, lubricants or other monitoring, cleaning up, removing, operating fluids escape from a containing, treating, detoxifying or vehicle part designed to hold, neutralizing, or in any way store or receive them. This responding to, or assessing the exception does not apply if the effects of, "pollutants".

"bodily injury" or "property However, this paragraph does not damage" arises out of the apply to liability for damages because intentional discharge, dispersal of "property damage" that the insured or release of the fuels, would have in the absence of such lubricants or other operating request, demand, order or statutory or fluids, or if such fuels, regulatory requirement, or such claim lubricants or other operating or "suit" by or on behalf of a fluids are brought on or to the governmental authority.

premises, site or location with the intent that they be discharged, dispersed or

Form SS 00 08 04 05 Page 5 of 24

g. Aircraft, Auto Or Watercraft (2) The use of "mobile equipment" in, or while in practice or preparation for, a"Bodily injury" or "property damage" arising prearranged racing, speed or out of the ownership, maintenance, use or demolition contest or in any stunting entrustment to others of any aircraft, "auto" activity.or watercraft owned or operated by or rented

i. Waror loaned to any insured. Use includes operation and "loading or unloading". "Bodily injury", "property damage" or This exclusion applies even if the claims "personal and advertising injury", however against any insured allege negligence or caused, arising, directly or indirectly, out of:

other wrongdoing in the supervision, hiring, (1) War, including undeclared or civil war;

employment, training or monitoring of others

(2) Warlike action by a military force, by that insured, if the "occurrence" which including action in hindering or caused the "bodily injury" or "property defending against an actual ordamage" involved the ownership, expected attack, by any government, maintenance, use or entrustment to others of sovereign or other authority usingany aircraft, "auto" or watercraft that is military personnel or other agents; orowned or operated by or rented or loaned to

(3) Insurrection, rebellion, revolution, any insured.

usurped power, or action taken by This exclusion does not apply to:

governmental authority in hindering or

(1) A watercraft while ashore on premises defending against any of these.

you own or rent;

j. Professio nal Servi ces

(2) A watercraft you do not own that is: "Bodily injury", "property damage" or

(a) Less than 51 feet long; and "personal and advertising injury" arising out of the rendering of or failure to render (b) Not being used to carry persons any professional service. This includes for a charge;

but is not limited to:(3) Parking an "auto" on, or on the ways

(1) Legal, accounting or advertisingnext to, premises you own or rent, services;provided the "auto" is not owned by or rented or loaned to you or the insured; (2) Preparing, approving, or failing to prepare or approve maps, shop(4) Liability assumed under any "insured drawings, opinions, reports, surveys,contract" for the ownership, field orders, change orders, designs ormaintenance or use of aircraft or drawings and specifications;watercraft;

(3) Supervisory, inspection, architectural (5) "Bodily injury" or "property damage" or engineering activities;arising out of the operation of any of f.(2)the equipment listed in Paragraph (4) Medical, surgical, dental, x-ray or f.(3)or of the definition of "mobile nursing services treatment, advice or equipment"; or instruction;

(6) An aircraft that is not owned by any (5) Any health or therapeutic service insured and is hired, chartered or loaned treatment, advice or instruction;

with a paid crew. However, this (6) Any service, treatment, advice or exception does not apply if the insured instruction for the purpose of has any other insurance for such "bodily appearance or skin enhancement, hair injury" or "property damage", whether removal or replacement or personal the other insurance is primary, excess, grooming;

contingent or on any other basis.

(7) Optical or hearing aid services

h. Mobile Equipmen t including the prescribing, preparation, "Bodily injury" or "property damage" fitting, demonstration or distribution of arising out of: ophthalmic lenses and similar products or hearing aid devices;(1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or

Page 6 of 24 Form SS 00 08 04 05

(8) (1) (3) (4)Optometry or optometric services Paragraphs , and of this including but not limited to examination exclusion do not apply to "property of the eyes and the prescribing, damage" (other than damage by fire) to preparation, fitting,demonstration or premises, including the contents of such distribution of ophthalmic lenses and premises, rented to you for a period of 7 or similar products; fewer consecutive days. A separate Limit of Insurance applies to Damage To (9) Any:

Premises Rented To You as described in

(a) Body piercing (not including ear D.Section - Limits Of Insurance.

piercing);

(2)Paragraph of this exclusion does not

(b) Tattooing, including but not limited apply if the premises are "your work" and to the insertion of pigments into or were never occupied, rented or held for under the skin; and rental by you.

(c) Similar services; (3) (4)Paragraphs and of this exclusion do

(10) Services in the practice of pharmacy; not apply to the use of elevators.

and (3) (4) (5) (6)Paragraphs , , and of this

(11) Computer consulting, design or exclusion do not apply to liability assumed programming services, including web under a sidetrack agreement.

site design. (3) (4)Paragraphs and of this exclusion do

(4) (5)Paragraphs and of this exclusion do not apply to "property damage" to not apply to the Incidental Medical borrowed equipment while not being used Malpractice coverage afforded under to perform operations at a job site.

1.e. A.Paragraph in Section - Coverages. (6)Paragraph of this exclusion does not

k. Damage To Prop erty apply to "property damage" included in the

"products-completed operations hazard"."Property damage" to:

l. Damage To Your Pro duct(1) Property you own, rent or occupy, including any costs or expenses "Property damage" to "your product" incurred by you, or any other person, arising out of it or any part of it.

organization or entity, for repair, m. Damage To Your Work replacement, enhancement, "Property damage" to "your work" arising restoration or maintenance of such out of it or any part of it and included in the property for any reason, including "products-completed operations hazard".prevention of injury to a person or damage to another's property; This exclusion does not apply if the damaged work or the work out of which (2) Premises you sell, give away or the damage arises was performed on your abandon, if the "property damage" arises behalf by a subcontractor.out of any part of those premises;

n. Damage To Impai red Prop erty Or (3) Property loaned to you;

Property Not Physi call y Injured

(4) Personal property in the care, custody "Property damage" to "impaired property" or control of the insured;

or property that has not been physically

(5) That particular part of real property on injured, arising out of:

which you or any contractors or

(1) A defect, deficiency, inadequacy or subcontractors working directly or dangerous condition in "your product" indirectly on your behalf are performing or "your work"; oroperations, if the "property damage"

(2)arises out of those operations; or A delay or failure by you or anyone acting on your behalf to perform a (6) That particular part of any property contract or agreement in accordance that must be restored, repaired or with its terms.replaced because "your work" was incorrectly performed on it. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use.

Form SS 00 08 04 05 Page 7 of 24

o. Recall Of Prod ucts, Work Or Impaired (c) Title of any literary or artistic work;

Property (8) Arising out of an offense committed by Damages claimed for any loss, cost or an insured whose business is:

(a)expense incurred by you or others for the Advertising, broadcasting, loss of use, withdrawal, recall, inspection, publishing or telecasting;

repair, replacement, adjustment, removal (b) Designing or determining content or disposal of: of web sites for others; or

(1) "Your product"; (c) An Internet search, access,

(2) "Your work"; or content or service provider.

(3) "Impaired property"; However, this exclusion does not if such product, work or property is a. b. c.apply to Paragraphs , and withdrawn or recalled from the market or under the definition of "personal and from use by any person or organization G.advertising injury" in Section – because of a known or suspected defect, Liability And Medical Expenses deficiency, inadequacy or dangerous Definitions.

condition in it. For the purposes of this exclusion,

p. Perso nal And Adverti sin g Injury placing an "advertisement" for or linking to others on your web site, by "Personal and advertising injury":

itself, is not considered the business

(1) Arising out of oral, written or electronic of advertising, broadcasting, publication of material, if done by or at publishing or telecasting;

the direction of the insured with

(9) Arising out of an electronic chat room knowledge of its falsity;

or bulletin board the insured hosts,

(2) Arising out of oral, written or electronic owns, or over which the insured publication of material whose first exercises control;

publication took place before the

(10) Arising out of the unauthorized use ofbeginning of the policy period;

another's name or product in your e-mail

(3) Arising out of a criminal act committed address, domain name or metatags, or by or at the direction of the insured; any other similar tactics to mislead

(4) Arising out of any breach of contract, another's potential customers;

except an implied contract to use (11) Arising out of the violation of a another’s "advertising idea" in your person's right of privacy created by "advertisement"; any state or federal act.

(5) Arising out of the failure of goods, However, this exclusion does not products or services to conform with apply to liability for damages that the any statement of quality or insured would have in the absence of performance made in your such state or federal act;

"advertisement";

(12) Arising out of:

(6) Arising out of the wrong description of

(a) An "advertisement" for others on the price of goods, products or services;

your web site;

(7) Arising out of any violation of any

(b) Placing a link to a web site of intellectual property rights such as others on your web site;copyright, patent, trademark, trade name, trade secret, service mark or (c) Content from a web site of others other designation of origin or displayed within a frame or border authenticity. on your web site. Content includes information, code, sounds, text,However, this exclusion does not graphics or images; orapply to infringement, in your

"advertisement", of (d) Computer code, software or programming used to enable:(a) Copyright;

(i) Your web site; or(b) Slogan, unless the slogan is also a trademark, trade name, service (ii) The presentation or functionality mark or other designation of origin of an "advertisement" or other or authenticity; or content on your web site;

Page 8 of 24 Form SS 00 08 04 05

(13) (a)Arising out of a violation of any anti- May be awarded or incurred by trust law; reason of any claim or suit alleging actual or threatened injury (14) Arising out of the fluctuation in price or or damage of any nature or kind to value of any stocks, bonds or other persons or property which would securities; or not have occurred in whole or in

(15) Arising out of discrimination or part but for the "asbestos hazard";

humiliation committed by or at the

(b) Arise out of any request, demand, direction of any "executive officer", order or statutory or regulatory director, stockholder, partner or requirement that any insured or member of the insured.

others test for, monitor, clean up,

q. Electron ic Data remove, encapsulate, contain, Damages arising out of the loss of, loss of treat, detoxify or neutralize or in use of, damage to, corruption of, inability any way respond to or assess the to access, or inability to manipulate effects of an "asbestos hazard"; or "electronic data". (c) Arise out of any claim or suit for

r. Employment-Rel ated Practices damages because of testing for, monitoring, cleaning up, removing,"Bodily injury" or "personal and advertising encapsulating, containing, treating,injury" to:

detoxifying or neutralizing or in any(1) A person arising out of any:

way responding to or assessing the

(a) Refusal to employ that person; effects of an "asbestos hazard".

(b) Termination of that person's t. Violatio n Of Statutes That Govern E-employment; or Mails, Fax, Phone Calls Or Other Metho ds Of Sending Materi al Or (c) Employment-related practices, Info rmatio npolicies, acts or omissions, such as coercion, demotion, evaluation, "Bodily injury", "property damage", or reassignment, discipline, "personal and advertising injury" arising defamation, harassment, humiliation directly or indirectly out of any action or or discrimination directed at that omission that violates or is alleged to person; or violate:

(2) The spouse, child, parent, brother or (1) The Telephone Consumer Protection sister of that person as a Act (TCPA), including any amendment consequence of "bodily injury" or of or addition to such law;

"personal and advertising injury" to the (2) The CAN-SPAM Act of 2003, including person at whom any of the any amendment of or addition to such employment-related practices law; or(a) (b) (c)described in Paragraphs , , or

(3) Any statute, ordinance or regulation,above is directed.

other than the TCPA or CAN-SPAM Act This exclusion applies:

of 2003, that prohibits or limits the

(1) Whether the insured may be liable as sending, transmitting, communicating or an employer or in any other capacity; distribution of material or information.

and Damage To Premi ses Rented To You –

(2) To any obligation to share damages Excep tio n For Damage By Fire, Lightni ng with or repay someone else who must or Exp losio n pay damages because of the injury. c. h. k. o.Exclusions through and through do

s. Asbestos not apply to damage by fire, lightning or explosion to premises rented to you or (1) "Bodily injury", "property damage" or temporarily occupied by you with permission of "personal and advertising injury" the owner. A separate Limit of Insurance arising out of the "asbestos hazard".

applies to this coverage as described in (2) Any damages, judgments, settlements, D.Section - Liability And Medical Expensesloss, costs or expenses that:

Limits Of Insurance.

Form SS 00 08 04 05 Page 9 of 24

2. Appl icab le To Medical Expen ses Co verage e. A trust, you are an insured. Your trustees are also insureds, but only with respect to We will not pay expenses for "bodily injury":

their duties as trustees.

a. Any Insu red

2. Each of the following is also an insured:To any insured, except "volunteer workers".

a. Employees A nd Volunteer Workersb. Hired Person Your "volunteer workers" only whileTo a person hired to do work for or on behalf performing duties related to the conduct of of any insured or a tenant of any insured.

your business, or your "employees", other

c. Injury On Normall y Occup ied Premi ses than either your "executive officers" (if you To a person injured on that part of are an organization other than a premises you own or rent that the person partnership, joint venture or limited liability normally occupies. company) or your managers (if you are a limited liability company), but only for acts d. Workers' Comp ensati on And Simil ar within the scope of their employment by Laws you or while performing duties related to

To a person, whether or not an the conduct of your business.

"employee" of any insured, if benefits for However, none of these "employees" or the "bodily injury" are payable or must be "volunteer workers" are insureds for:provided under a workers' compensation or disability benefits law or a similar law. (1) "Bodily injury" or "personal and advertising injury":e. Athleti cs A cti viti es

(a) To you, to your partners or To a person injured while practicing, members (if you are a partnership instructing or participating in any physical or joint venture), to your members exercises or games, sports or athletic (if you are a limited liability contests.

company), or to a co-"employee"f. Products-Completed Operations Hazard while in the course of his or her

Included with the "products-completed employment or performing duties operations hazard". related to the conduct of your business, or to your other g. Busin ess L iabil ity Exclu sio ns "volunteer workers" while Excluded under Business Liability Coverage.

performing duties related to the

C. WHO IS AN INSURED conduct of your business;

1. If you are designated in the Declarations as: (b) To the spouse, child, parent, brother or sister of that co-a. An individual, you and your spouse are "employee" or that "volunteer insureds, but only with respect to the worker" as a consequence of conduct of a business of which you are the

(1)(a)Paragraph above;sole owner.

(c) For which there is any obligation b. A partnership or joint venture, you are an to share damages with or repay insured. Your members, your partners, and someone else who must pay their spouses are also insureds, but only with damages because of the injury respect to the conduct of your business.

(1)(a)described in Paragraphs orc. A limited liability company, you are an (b) above; or insured. Your members are also insureds,

(d) Arising out of his or her providing but only with respect to the conduct of your or failing to provide professional business. Your managers are insureds, but health care services.only with respect to their duties as your managers. If you are not in the business of providing professional health cared. An organization other than a partnership, (d)services, Paragraph does not applyjoint venture or limited liability company, you to any nurse, emergency medicalare an insured. Your "executive officers" and technician or paramedic employed bydirectors are insureds, but only with respect you to provide such services.to their duties as your officers or directors.

Your stockholders are also insureds, but only (2) "Property damage" to property:

with respect to their liability as stockholders. (a) Owned, occupied or used by, Page 10 of 24 Form SS 00 08 04 05

(b) b.Rented to, in the care, custody or Coverage under this provision does not control of, or over which physical apply to:

control is being exercised for any (1) "Bodily injury" or "property damage" purpose by you, any of your that occurred; or "employees", "volunteer workers",

(2) "Personal and advertising injury" any partner or member (if you are arising out of an offense committeda partnership or joint venture), or before you acquired or formed the any member (if you are a limited organization.liability company).

4. Operato r Of Mobile Equipmen tb. Real Estate Manager With respect to "mobile equipment" registered inAny person (other than your "employee" or your name under any motor vehicle registration"volunteer worker"), or any organization law, any person is an insured while driving suchwhile acting as your real estate manager.

equipment along a public highway with yourc. Tempo rary Custod ians Of Your permission. Any other person or organizationProperty responsible for the conduct of such person is

Any person or organization having proper also an insured, but only with respect to liability temporary custody of your property if you arising out of the operation of the equipment, and die, but only: only if no other insurance of any kind is available

(1) With respect to liability arising out of the to that person or organization for this liability.

maintenance or use of that property; and However, no person or organization is an insured with respect to:(2) Until your legal representative has been appointed. a. "Bodily injury" to a co-"employee" of the person driving the equipment; ord. Legal Representati ve If You Die

b. "Property damage" to property owned by, Your legal representative if you die, but rented to, in the charge of or occupied byonly with respect to duties as such. That you or the employer of any person who is representative will have all your rights and an insured under this provision.duties under this insurance.

5. Operato r of Nonowned Watercrafte. Unnamed Subsi diary With respect to watercraft you do not own that Any subsidiary and subsidiary thereof, of is less than 51 feet long and is not being used yours which is a legally incorporated entity to carry persons for a charge, any person is an of which you own a financial interest of insured while operating such watercraft with more than 50% of the voting stock on the your permission. Any other person or effective date of this Coverage Part.

organization responsible for the conduct of

The insurance afforded herein for any such person is also an insured, but only with subsidiary not shown in the Declarations respect to liability arising out of the operation as a named insured does not apply to of the watercraft, and only if no other injury or damage with respect to which an insurance of any kind is available to that insured under this insurance is also an person or organization for this liability.

insured under another policy or would be

However, no person or organization is an an insured under such policy but for its insured with respect to:termination or upon the exhaustion of its limits of insurance. a. "Bodily injury" to a co-"employee" of the person operating the watercraft; or3. Newly Acqu ired Or Formed Organ izati on

b. "Property damage" to property owned by,Any organization you newly acquire or form, rented to, in the charge of or occupied by other than a partnership, joint venture or you or the employer of any person who is limited liability company, and over which you an insured under this provision.maintain financial interest of more than 50% of the voting stock, will qualify as a Named 6. Addi tio nal Insured s When Requi red By Insured if there is no other similar insurance Written Contract, Written Agreemen t Or available to that organization. However: Permi t

a. Coverage under this provision is afforded The person(s) or organization(s) identified in only until the 180th day after you acquire a. f.Paragraphs through below are additional or form the organization or the end of the insureds when you have agreed, in a written policy period, whichever is earlier; and

Form SS 00 08 04 05 Page 11 of 24

(e)contract, written agreement or because of a Any failure to make such permit issued by a state or political inspections, adjustments, tests or subdivision, that such person or organization servicing as the vendor has be added as an additional insured on your agreed to make or normally policy, provided the injury or damage occurs undertakes to make in the usual subsequent to the execution of the contract or course of business, in connection agreement, or the issuance of the permit. with the distribution or sale of the products;A person or organization is an additional

(f) Demonstration, installation, insured under this provision only for that…